title: Prognostic value of multidetector computed tomography coronary angiography in diabetes: excellent long-term prognosis in patients with normal coronary arteries.
abstract: OBJECTIVE
  To assess the prognostic role of multidetector computed tomography coronary angiography (MDCT-CA) in patients with diabetes with suspected coronary artery disease (CAD). Use of MDCT-CA is increasing in patients with suspected CAD. However, data supporting its prognostic value in patients with diabetes are limited.
  
  
  METHODS
  Between January 2006 and September 2007, 429 consecutive diabetic patients were prospectively studied with MDCT-CA for detecting the presence and assessing the extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronary arteries and nonobstructive (<50%) and obstructive (≥50%) coronary lesions. The composite rates of hard cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina) and all cardiac events (including revascularization) were the end points of the study.
  
  
  RESULTS
  Twenty-four patients were excluded because MDCT-CA data were not able to be interpreted. Of the remaining 405 patients, clinical follow-up (mean 62 ± 9 months) was obtained in 390 (98%). Multivariate analysis showed that predictors of hard and all events were obstructive CAD, three-vessel CAD, and left main coronary artery (LMCA) disease. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 78% for hard events and 56% for all events in patients with nonobstructive CAD, and 60% for hard events and 16% for all events in patients with obstructive CAD. Three-vessel CAD and LMCA disease were associated with a higher rate of hard cardiac events.
  
  
  CONCLUSIONS
  MDCT-CA provides long-term prognostic information for patients with diabetes with suspected CAD, showing excellent prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.
authors.affiliation: Centro Cardiologico Monzino, Istituto Di Ricovero e Cura a Carattere Scientifico, Milan, Italy. daniele.andreini@ccfm.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.forename: Erika
authors.initials: E
authors.lastname: Bertella
authors.forename: Edoardo
authors.initials: E
authors.lastname: Conte
authors.forename: Andrea
authors.initials: A
authors.lastname: Baggiano
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Annoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Formenti
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ballerini
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging*; D006801:Humans; D061330:Multidetector Computed Tomography; D011446:Prospective Studies